Spinal interbody implants

ABSTRACT

Spinal interbody fusion implants for use in posterior lumbar interbody fusions (PLIF), anterior lumbar interbody fusions (ALIF), transforaminal lumbar interbody fusions (TLIF) and transpsoas interbody fusions (DLIF), each of the implants including a 3-D printed titanium frame having meshed sidewalls, open top and bottom faces and a selectively closeable back plate for enclosing a posterior end of the frame. A machined, acid treated allograft bone graft is contained within the frame, the bone graft having a window for containing a biomaterial, anti-migration teeth and a ridge configured to mate with a slot within the frame for locking the graft in the frame.

RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationNo. 62/849,346 filed on May 17, 2019, titled “Spinal InterbodyImplants”, the entire contents of which are incorporated herein byreference.

FIELD OF USE

The present invention is directed to spinal implants and, moreparticularly, to spinal interbody fusion implants for use in posteriorlumbar interbody fusions (PLIF), anterior lumbar interbody fusions(ALIF), transforaminal lumbar interbody fusions (TLIF) and transpsoasinterbody fusions (DLIF), each of the implants including a 3-D printedtitanium frame having meshed sidewalls, open top and bottom faces and aselectively closeable back-plate for enclosing a posterior end of theframe and a machined, acid treated allograft bone graft contained withinthe frame, the bone graft having anti-migration teeth and a window forcontaining a biomaterial.

BACKGROUND OF INVENTION

Spinal fusion, also called spondylodesis or spondylosyndesis, is aneurosurgical or orthopedic surgical technique that joins two or morevertebrae. The procedure can be performed at any level in the spine(cervical, thoracic, or lumbar) and prevents any movement between thefused vertebrae. There are many types of spinal fusion and eachtechnique involves using bone grafting, either from the patient(autograft), donor (allograft), or artificial bone substitutes, to helpthe bones heal together.

Interbody fusion is a graft where the entire intervertebral disc betweenvertebrae is removed, and a bone graft is placed in the space betweenthe vertebra. A plastic or titanium device may be placed between thevertebra to maintain spine alignment and disc height. The types ofinterbody fusion are (1) anterior lumbar interbody fusion (ALIF), wherethe disc is accessed from an anterior abdominal incision, (2) aosteriorlumbar interbody fusion (PLIF), where the disc is accessed from aposterior incision, (3) transforaminal lumbar interbody fusion (TLIF)where the disc is accessed from a posterior incision on one side of thespine, (4) transpsoas interbody fusion (DLIF), where the disc isaccessed from an incision through the psoas muscle on one side of thespine, and (5) oblique lateral lumbar interbody fusion (OLLIF), wherethe disc is accessed from an incision through the psoas muscleobliquely.

Exemplary spinal interbody implants are disclosed in U.S. PatentApplication Publication No. 2018/0256336; France Patent Document No.FR2923155A; and U.S. Pat. No. 7,641,690.

PLIF

Referring to FIGS. 1 through 7, a PLIF is a surgery designed to stop themotion at the targeted segment of the spine. A PLIF is done in thelumbar, or lower, spine. Most commonly it is performed on the L4-L5 orL5-S1 segment at the bottom of the lumbar spine. This surgery may bedone to treat lumbar degenerative disc disease, in which a degenerateddisc becomes painful. It may also be done for a lumbarspondylolisthesis, in which one vertebra slips forward over the vertebrabelow it. A PLIF starts with a three to six-inch long incision in themidline of the back. Next, the lower back muscles, called erectorspinae, are stripped off the lamina on both sides and at multiplelevels. The lamina is removed, which allows visualization of the nerveroots. The facet joints, which are directly over the nerve root, maythen be trimmed to give the nerve roots more room. The nerve roots arethen retracted to one side and the disc space is cleaned of the discmaterial. Some type of implant, called a cage, is then inserted into thedisc space. The cage helps restore more of the normal spacing in betweenthe vertebrae, alleviating pressure on the nerve roots. Bone graft isplaced in the cage and along the sides of the spine. There are many bonegraft options. If the patient's own bone graft is used, bone morsels areharvested from the patient's iliac crest, along the back of the hip.This is an additional surgical procedure that is done at the same timeas the fusion surgery. Bone that has been removed from a laminectomy mayalso be used, or synthetic bone graft options may be used. The surgeonmay implant a series of screws and rods to the back of the spine foradditional support. A PLIF fusion may be supplemented by a simultaneousposterolateral spine fusion surgery. In addition to open surgery, a PLIFmay sometimes be done through a tube in a minimally invasive approach.

TLIF

Referring to FIGS. 8 through 15, TLIF back surgery is done through theposterior (back) part of the spine. Surgical hardware is applied to thespine to help enhance the fusion rate. Pedicle screws and rods areattached to the back of the vertebra and an interbody fusion spacer isinserted into the disc space from one side of the spine. Bone graft isplaced into the interbody space and alongside the back of the vertebrato be fused. Bone graft is obtained from the patient's pelvis, althoughbone graft substitutes are also sometimes used. As the bone graft heals,it fuses the vertebra above and below and forms one long bone. TLIFfuses the anterior (front) and posterior (back) columns of the spinethrough a single posterior approach. The anterior portion of the spineis stabilized by the bone graft and interbody spacer. The posteriorcolumn is locked in place with pedicle screws, rods, and bone graft.TLIF procedure has several theoretical advantages over some other formsof lumbar fusion: Bone fusion is enhanced because bone graft is placedboth along the gutters of the spine posteriorly but also in the discspace. A spacer is inserted into the disc space helping to restorenormal height and opening up nerve foramina to take pressure off thenerve roots. A TLIF procedure allows the surgeon to insert bone graftand spacer into the disc space from a unilateral approach laterallywithout having to forcefully retract the nerve roots as much, which mayreduce injury and scarring around the nerve roots when compared to aPLIF procedure. Pedicle screws are placed into the vertebra. Exposure ofthe disc space is done on one side by removing the facet joints andprotecting the nerve roots. The disc space is entered and disc materialis removed. Bone graft is obtained from the patient's iliac crest (thehip). A spacer or interbody cage that is filled with bone graft isplaced into the disc space to maintain the disc height. Additional boneis placed in the lateral (side) gutters of the vertebra and the discspace. Pedicle screws are attached to rods or plates. The wound isclosed.

ALIF

Referring to FIGS. 16 through 24, an ALIF is designed to stop the motionat the symptomatic segment of the spine. An ALIF is done in the lumbar,or lower, spine. Most commonly it is performed on the L4 through L5 orL5 through 51 segment at the bottom of the lumbar spine, as thesesegments are most likely to break down. An ALIF is most commonly done totreat lumbar degenerative disc disease, in which a degenerated discbecomes painful. It may be done for other indications and may becombined with a posterior approach as well, if added stability isneeded. This type of fusion is unique as the surgery is done from thefront, or anterior. It starts with a 3 to 5-inch long incision on theleft side of the abdomen. Next, the abdomen muscles are retracted to theside. The abdominal contents lay inside a large sack (the peritoneum)that is then retracted to the side, allowing access to the front of thespine without actually entering the abdomen. The large blood vessels,called the aorta and vena cava, lay on top of the spine, so a vascularsurgeon will usually be part of the surgery to move the large bloodvessels to the side. After the blood vessels have been moved aside, thedisc material is removed. Some type of implant, called a cage, is theninserted into the disc space. The cage helps restore more of the normalspacing in between the vertebrae, alleviating pressure on the nerveroots. Bone graft is placed in the cage and sometimes in front of thecage. Sometimes additional fixation is used by inserting screws throughthe cage. If the patient's own bone graft is used, bone morsels areharvested from the front of the patient's iliac crest, or hip bone. Thisis an additional surgical procedure that is done at the same time as thefusion surgery. Synthetic bone graft options are may also be used. Inthe months following the surgery, the bone graft heals together throughand alongside the cage, creating one long bone between the vertebrae andimmobilizing that segment of the spine. An ALIF may be combined with asimultaneous posterolateral fusion, with an approach from the back ofthe spine, if additional stability is needed to help ensure a successfulfusion.

DLIF

Referring to FIGS. 25 through 30, the DLIF procedure involves a smallskin incision in a patient's side (therefore, direct lateral). Usingminimally invasive surgical techniques, the neurosurgeon separatesmuscles (psoas muscle) and soft tissues to access the intervertebraldisc. Because access to the spine is through the psoas muscle, DLIF issometimes called a trans-psoas LIF or approach. The patient is givengeneral anesthesia. The surgeon then makes two small incisions in theside of the patient. These incisions are very small as compared to thetraditional incisions made in the back surgery procedures. The surgeoninserts a probe in one of the incisions. The probe stimulates anddetects the nerves around the spine and helps the surgeon to avoid thenerves and to leave them undamaged. The surgeon uses the second incisionto help guide the surgical instruments. When the probe reaches at theproper position, the surgeon inserts a series of dilation tubes over theprobe. This helps to create a larger opening. The surgeon then inserts aretraction device over the dilation tubes. This device helps to moveaside the muscle tissues and to provide access to the spine. The surgeonoperates through the channel created by the retractor device and removesthe damaged disc. The surgeon then places an implant filled with bonegraft in the empty disc space. The implant realigns the vertebral bonesand lifts pressure from the pinched spinal nerves. The bone graft willgrow and form a fusion to connect the vertebral bodies. The retractordevice is removed and the incisions are closed. The wounds are cleanedand medical bandage is applied

SUMMARY OF INVENTION

The present invention is directed to spinal interbody fusion implantsfor use in posterior lumbar interbody fusions (PLIF), anterior lumbarinterbody fusions (ALIF), transforaminal lumbar interbody fusions (TLIF)and transpsoas interbody fusions (DLIF). According to one aspect of theinvention, there is provided a spinal implant including a 3-D printedtitanium enclosure and a CNC machined, acid treated allograft bone graftcontained within the enclosure.

The enclosure includes a first sidewall, a first mesh window extendingthrough the first sidewall, a second sidewall opposing the firstsidewall, a second mesh window extending through the second sidewall, asubstantially convex third sidewall extending to and between the firstsidewall and the second sidewall, the third sidewall forming a first endof the enclosure, a second end opposite the first end, a fourth sidewallopposing the third sidewall and hingedly coupled to the first sidewalland detachably coupled to the second sidewall, the a longitudinal axisextending through a center of the third sidewall and a center of thefourth sidewall, a substantially U-shaped top wall with a substantiallyU-shaped top opening there through, and a substantially U-shaped bottomwall with a substantially U-shaped bottom opening there through. Thefirst sidewall, the second sidewall and the third sidewall form asubstantially U-shaped sidewall defining a substantially U-shaped slothaving an upper seat portion and a lower seat portion.

The allograft bone graft includes a first face, a second face opposingthe first face, a substantially convex third face extending to andbetween the first face and the second face, wherein the longitudinalaxis extends through a center of the third face, a fourth face opposingthe third face having a substantially cross-shaped cross-section,wherein the longitudinal axis extends through a center of the fourthface, a top face including anti-migration ridges, a bottom faceincluding anti-migration ridges, and a hole extending to and between thetop face and the bottom face. The first face, the second face and thethird face form a substantially U-shaped face including a substantiallyU-shaped protrusion extending along a length of the U-shaped face anddefining a graft upper ledge and a graft lower ledge. The bone graft isprovided as a unitary block of bone. The block of bone may be treated ormachined to include openings therein and there through or to increaseporosity of the block.

In one embodiment, the allograft bone graft is contained within theenclosure with the a graft upper ledge engaged with the upper seatportion and the graft lower ledge engaged with the lower seat portion.In another embodiment, the top face and the bottom face taper inwardlytoward the longitudinal axis at the first end of the enclosure. Inanother embodiment, the first sidewall and the second sidewall areparallel. In another embodiment, the top face and the bottom face areconvex. In another embodiment, the top face extends out of the enclosurethrough the top opening and the bottom face extends out of the enclosurethrough the bottom opening. In another embodiment, the fourth sidewallis fabricated from nickel titanium alloy or cobalt. In anotherembodiment, the implant includes a biomaterial contained within the holeextending to and between the top face and the bottom face. In anotherembodiment, the first sidewall is convex and the second sidewall isconcave. In another embodiment, the first face is convex and the secondface is concave. In another embodiment, the allograft bone graft ispre-hydrated. In another embodiment, the first sidewall, the secondsidewall, the third sidewall, the top wall and the bottom wall areporous. In another embodiment, the first sidewall and the secondsidewall taper inwardly towards the longitudinal axis at the second endof the enclosure. In another embodiment, the first face and the secondface taper inwardly towards the longitudinal axis at the second end ofthe enclosure. In another embodiment, the top face and the bottom faceare parallel. In yet another embodiment, the implant includes a thirdmesh window extending through the first sidewall and a fourth meshwindow extending through the second sidewall. In another embodiment, theimplant includes a second hole extending to and between the top face andthe bottom face.

According to a second aspect of the invention, there is provided asurgical method for vertebral interbody fusion including providing aspinal implant including a 3-D printed titanium enclosure and a CNCmachined, acid treated allograft bone graft contained within theenclosure and inserting one or more of the spinal implants between afirst vertebra and a second vertebra. The surgical method may be asurgical procedure a posterior lumbar interbody fusion (PLIF) procedure,an anterior lumbar interbody fusion (ALIF) procedure, a transforaminallumbar interbody fusion (TLIF) procedure or a transpsoas interbodyfusions (DLIF) procedure.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1 through 7 depict a PLIF procedure in accordance with the priorart.

FIGS. 8 through 15 depict a TLIF procedure in accordance with the priorart.

FIGS. 16 through 24 depict an ALIF procedure in accordance with theprior art.

FIGS. 25 through 30 depict a DLIF procedure in accordance with the priorart.

FIG. 31 is a perspective view of an anterior end of a PLIF implantillustrating an allograft bone graft contained with a cage.

FIG. 32 is a perspective view of a posterior end of the PLIF implant ofFIG. 31.

FIG. 33 is a elevational view of an anterior end of the cage of the PLIFimplant of FIG. 31.

FIG. 34 is a elevational view of a lateral side of the cage of FIG. 33.

FIG. 35 is a elevational view of a posterior end of cage of FIG. 33.

FIG. 36 is a top plan view of the cage of FIG. 33.

FIG. 37 is a perspective view of the cage of FIG. 33.

FIG. 38 is a elevational view of an anterior end of the graft of thePLIF implant of FIG. 31.

FIG. 39 is a elevational view of a lateral side of the graft of FIG. 38.

FIG. 40 is a elevational view of a posterior end of graft of FIG. 38.

FIG. 41 is a top plan view of the graft of FIG. 38.

FIG. 42 is a perspective view of the graft of FIG. 38.

FIG. 43 is an exploded perspective view of the posterior end of the PLIFimplant of FIG. 31.

FIG. 44 is a elevational view of an anterior end of the PLIF implant ofFIG. 31.

FIG. 45 is a elevational view of a lateral side of the PLIF implant ofFIG. 31.

FIG. 46 is a elevational view of a posterior end of PLIF implant of FIG.31.

FIG. 47 is a top plan view of the PLIF implant of FIG. 31.

FIG. 48 is a perspective view of an anterior end of a TLIF implantillustrating an allograft bone graft contained with a cage.

FIG. 49 is a perspective view of a posterior end of the TLIF implant ofFIG. 48.

FIG. 50 is a elevational view of an anterior end of the cage of the TLIFimplant of FIG. 48.

FIG. 51 is a elevational view of a lateral side of the cage of FIG. 50.

FIG. 52 is a elevational view of a posterior end of cage of FIG. 50.

FIG. 53 is a top plan view of the cage of FIG. 50.

FIG. 54 is a perspective view of the cage of FIG. 50.

FIG. 55 is a elevational view of an anterior end of the graft of theTLIF implant of FIG. 48.

FIG. 56 is a elevational view of a lateral side of the graft of FIG. 55.

FIG. 57 is a elevational view of a posterior end of graft of FIG. 55.

FIG. 58 is a top plan view of the graft of FIG. 55.

FIG. 59 is a perspective view of the graft of FIG. 55.

FIG. 60 is an exploded perspective view the posterior end of the TLIFimplant of FIG. 48.

FIG. 61 is a elevational view of THE anterior end of the TLIF implant ofFIG. 48.

FIG. 62 is a elevational view of a lateral side of the TLIF implant ofFIG. 48.

FIG. 63 is a elevational view of a posterior end of TLIF implant of FIG.48.

FIG. 64 is a top plan view of the TLIF implant of FIG. 48.

FIG. 65 is a perspective view of an anterior end of a ALIF implantillustrating an allograft bone graft contained with a cage.

FIG. 66 is a perspective view of a posterior end of the ALIF implant ofFIG. 65.

FIG. 67 is a elevational view of an anterior end of the cage of the ALIFimplant of FIG. 65.

FIG. 68 is a elevational view of a lateral side of the cage of FIG. 67.

FIG. 69 is a elevational view of a posterior end of cage of FIG. 67.

FIG. 70 is a top plan view of the cage of FIG. 67.

FIG. 71 is a perspective view of the cage of FIG. 67.

FIG. 72 is a elevational view of an anterior end of the graft of theALIF implant of FIG. 65.

FIG. 73 is a elevational view of a lateral side of the graft of FIG. 72.

FIG. 74 is a elevational view of a posterior end of graft of FIG. 72.

FIG. 75 is a top plan view of the graft of FIG. 72.

FIG. 76 is a perspective view of the graft of FIG. 72.

FIG. 77 is an exploded perspective view the posterior end of the ALIFimplant of FIG. 65.

FIG. 78 is a elevational view of THE anterior end of the ALIF implant ofFIG. 65.

FIG. 79 is a elevational view of a lateral side of the ALIF implant ofFIG. 65.

FIG. 80 is a elevational view of a posterior end of ALIF implant of FIG.65.

FIG. 81 is a top plan view of the ALIF implant of FIG. 65.

FIG. 82 is a perspective view of an anterior end of a DLIF implantillustrating an allograft bone graft contained with a cage.

FIG. 83 is a perspective view of a posterior end of the DLIF implant ofFIG. 82.

FIG. 84 is a elevational view of an anterior end of the cage of the DLIFimplant of FIG. 82.

FIG. 85 is a elevational view of a lateral side of the cage of FIG. 84.

FIG. 86 is a elevational view of a posterior end of cage of FIG. 84.

FIG. 87 is a top plan view of the cage of FIG. 84.

FIG. 88 is a perspective view of the cage of FIG. 84.

FIG. 89 is a elevational view of an anterior end of the graft of theDLIF implant of FIG. 82.

FIG. 90 is a elevational view of a lateral side of the graft of FIG. 89.

FIG. 91 is a elevational view of a posterior end of graft of FIG. 89.

FIG. 92 is a top plan view of the graft of FIG. 89.

FIG. 93 is a perspective view of the graft of FIG. 89.

FIG. 94 is an exploded perspective view the posterior end of the DLIFimplant of FIG. 82.

FIG. 95 is a elevational view of the anterior end of the DLIF implant ofFIG. 82.

FIG. 96 is a elevational view of a lateral side of the DLIF implant ofFIG. 82.

FIG. 97 is a elevational view of a posterior end of DLIF implant of FIG.82.

FIG. 98 is a top plan view of the DLIF implant of FIG. 82.

DETAILED DESCRIPTION

The present invention is directed to spinal interbody fusion implantsfor use in posterior lumbar interbody fusions (PLIF), anterior lumbarinterbody fusions (ALIF), transforaminal lumbar interbody fusions (TLIF)and transpsoas interbody fusions (DLIF). FIGS. 31 through 47 depict aPLIF implant 100 in accordance with a first embodiment of the presentinvention. FIGS. 48 through 64 depict a TLIF implant 200 in accordancewith a second embodiment of the present invention. FIGS. 65 through 81depict an ALIF implant 300 in accordance with a third embodiment of thepresent invention, and FIGS. 82 through 98 depict a DLIF implant 400 inaccordance with a fourth embodiment of the present invention. FIGS. 1through 7 depict a PLIF procedure in accordance with the prior art withwhich PLIF implant 100 may be implemented. FIGS. 8 through 15 depict aTLIF procedure in accordance with the prior art with which TLIF implant200 may be implemented. FIGS. 16 through 24 depict an ALIF procedure inaccordance with the prior art with which ALIF implant 300 may beimplemented, and FIGS. 25 through 30 depict a DLIF procedure inaccordance with the prior art with which DLIF implant 400 may beimplemented. Generally, the spinal interbody fusion implants of thepresent invention include a 3-D printed titanium frame having meshedsidewalls, open top and bottom faces and a selectively closeable backplate for enclosing a posterior end of the frame. A machined, acidtreated allograft bone graft is contained within the frame, the bonegraft having a window for containing a biomaterial, anti-migration teethand a ridge configured to mate with a slot within the frame for lockingthe graft in the frame.

PLIF

More particularly, referring to FIGS. 31 through 47, PLIF implant 100includes a 3-D printed titanium enclosure 110 having a first sidewall112, a first mesh window 114 extending through the first sidewall, asecond sidewall 116 opposing the first sidewall, a second mesh window118 extending through the second sidewall, a substantially convex thirdsidewall 120 extending to and between the first sidewall and the secondsidewall, the third sidewall 120 forming a first end 124 of theenclosure, a second end 126 opposite the first end, a fourth sidewall128 opposing the third sidewall and hingedly coupled to the secondsidewall and detachably coupled to the first sidewall, a longitudinalaxis extending through a center of the third sidewall and a center ofthe fourth sidewall, a substantially U-shaped top wall 130 with asubstantially U-shaped top opening 132 there through, and asubstantially U-shaped bottom wall 134 with a substantially U-shapedbottom opening 136 there through. The first sidewall, the secondsidewall and the third sidewall form a substantially U-shaped sidewalldefining a substantially U-shaped slot 138 having an upper seat portion140 and a lower seat portion 142. As depicted in FIGS. 33 and 34, topwall 130 and bottom wall 134 taper inwardly toward first end 124.

PLIF allograft bone graft 150 includes a substantially convex first face152, a substantially convex second face 154 opposing the first face, asubstantially convex third face 156 extending to and between the firstface and the second face, wherein the longitudinal axis extends througha center of the third face, a fourth face 158 opposing the third facehaving a substantially cross-shaped cross-section, wherein thelongitudinal axis extends through a center of the fourth face, a topface 160 including anti-migration ridges 162, a bottom face 164including anti-migration ridges 162, and a hole 166 extending to andbetween the top face and the bottom face. The first face, the secondface and the third face form a substantially U-shaped face including asubstantially U-shaped protrusion 168 extending along a length of theU-shaped face and defining a graft upper ledge 170 and a graft lowerledge 172.

In use, fourth sidewall 128 is pivoted open, and PLIF allograft bonegraft 150 is inserted into enclosure 110 through the open doorway withthe a graft upper ledge 170 engaged with the upper seat portion 140 andthe graft lower ledge 172 engaged with the lower seat portion 142.Fourth sidewall 128 is then closed and fixed shut. Once assembled, PLIFimplant 100 may be used to fuse adjacent vertebra according to themethod illustrated in FIGS. 1 through 7 and described above, with topand bottom faces 160, 164 protruding out through U-shaped slot 138 sothat anti-migration ridges 162 may directly contact adjacent thevertebrae.

TLIF

Referring to FIGS. 48 through 64, TLIF implant 200 includes a 3-Dprinted titanium enclosure 210 having a substantially convex firstsidewall 212, a first mesh window 214 extending through the firstsidewall, a substantially concave second sidewall 216 opposing the firstsidewall, a second mesh window 218 extending through the secondsidewall, a substantially convex third sidewall 220 extending to andbetween the first sidewall and the second sidewall, the third sidewall220 forming a first end 224 of the enclosure, a second end 226 oppositethe first end, a fourth sidewall 228 opposing the third sidewall andhingedly coupled to the second sidewall and detachably coupled to thefirst sidewall, a substantially U-shaped top wall 230 with asubstantially U-shaped top opening 232 there through, and asubstantially U-shaped bottom wall 234 with a substantially U-shapedbottom opening 236 there through. The first sidewall, the secondsidewall and the third sidewall form a substantially U-shaped sidewalldefining a substantially U-shaped slot 238 having an upper seat portion240 and a lower seat portion 242.

TLIF allograft bone graft 250 includes a substantially convex first face252, a substantially concave second face 254 opposing the first face, asubstantially convex third face 256 extending to and between the firstface and the second face, a fourth face 258 opposing the third facehaving a substantially cross-shaped cross-section, a substantiallyconvex top face 260 including anti-migration ridges 262, a substantiallyconvex bottom face 264 including anti-migration ridges 262, and a hole266 extending to and between the top face and the bottom face. The firstface, the second face and the third face form a substantially U-shapedface including a substantially U-shaped protrusion 268 extending along alength of the U-shaped face and defining a graft upper ledge 270 and agraft lower ledge 272.

In use, fourth sidewall 228 is pivoted open, and TLIF allograft bonegraft 250 is inserted into enclosure 210 through the open doorway withthe a graft upper ledge 270 engaged with the upper seat portion 1240 andthe graft lower ledge 272 engaged with the lower seat portion 242.Fourth sidewall 228 is then closed and fixed shut. Once assembled, TLIFimplant 200 may be used to fuse adjacent vertebra according to themethod illustrated in FIGS. 8 through 15 and described above, with topand bottom faces 260, 264 protruding out through U-shaped slot 238 sothat anti-migration ridges 262 may directly contact adjacent thevertebrae.

ALIF

Referring to FIGS. 65 through 81, ALIF implant 300 includes a 3-Dprinted titanium enclosure 310 having a first sidewall 312, a first meshwindow 314 extending through the first sidewall, a second sidewall 316opposing the first sidewall, a second mesh window 318 extending throughthe second sidewall, a substantially convex third sidewall 320 extendingto and between the first sidewall and the second sidewall, the thirdsidewall 320 forming a first end 324 of the enclosure, a second end 326opposite the first end, a fourth sidewall 328 opposing the thirdsidewall and hingedly coupled to the second sidewall and detachablycoupled to the first sidewall, a longitudinal axis extending through acenter of the third sidewall and a center of the fourth sidewall, asubstantially U-shaped top wall 330 with a substantially U-shaped topopening 332 there through, and a substantially U-shaped bottom wall 334with a substantially U-shaped bottom opening 336 there through. Thefirst sidewall, the second sidewall and the third sidewall form asubstantially U-shaped sidewall defining a substantially U-shaped slot338 having an upper seat portion 340 and a lower seat portion 342.U-shaped slot 338 has a width defined between sidewall 312, 316 thattapers inwardly from first end to 324 to second end 326.

ALIF allograft bone graft 350 includes a first face 352, a second face354 opposing the first face, a substantially convex third face 356extending to and between the first face and the second face, wherein thelongitudinal axis extends through a center of the third face, a fourthface 358 opposing the third face having a substantially cross-shapedcross-section, wherein the longitudinal axis extends through a center ofthe fourth face, a top face 360 including anti-migration ridges 362, abottom face 364 including anti-migration ridges 362, and a hole 366extending to and between the top face and the bottom face. The firstface, the second face and the third face form a substantially U-shapedface including a substantially U-shaped protrusion 368 extending along alength of the U-shaped face and defining a graft upper ledge 370 and agraft lower ledge 372.

In use, fourth sidewall 1328 is pivoted open, and ALIF allograft bonegraft 350 is inserted into enclosure 310 through the open doorway withthe a graft upper ledge 370 engaged with the upper seat portion 340 andthe graft lower ledge 372 engaged with the lower seat portion 342.Fourth sidewall 328 is then closed and fixed shut. Once assembled, ALIFimplant 300 may be used to fuse adjacent vertebra according to themethod illustrated in FIGS. 16 through 24 and described above, with topand bottom faces 360, 364 protruding out through U-shaped slot 338 sothat anti-migration ridges 362 may directly contact adjacent thevertebrae.

DLIF

Referring to FIGS. 82 through 98, DLIF implant 400 includes a 3-Dprinted titanium enclosure 410 having a first sidewall 412, a pair offirst mesh windows 414 extending through the first sidewall, a secondsidewall 416 opposing the first sidewall, a pair of second mesh windows418 extending through the second sidewall, a substantially convex thirdsidewall 420 extending to and between the first sidewall and the secondsidewall, the third sidewall 420 forming a first end 424 of theenclosure, a second end 426 opposite the first end, a fourth sidewall428 opposing the third sidewall and hingedly coupled to the secondsidewall and detachably coupled to the first sidewall, a longitudinalaxis extending through a center of the third sidewall and a center ofthe fourth sidewall, a substantially U-shaped top wall 430 with asubstantially U-shaped top opening 432 there through, and asubstantially U-shaped bottom wall 434 with a substantially U-shapedbottom opening 436 there through. The first sidewall, the secondsidewall and the third sidewall form a substantially U-shaped sidewalldefining a substantially U-shaped slot 438 having an upper seat portion440 and a lower seat portion 442.

DLIF allograft bone graft 450 includes a first face 452, a second face454 opposing the first face, a substantially convex third face 456extending to and between the first face and the second face, wherein thelongitudinal axis extends through a center of the third face, a fourthface 458 opposing the third face having a substantially cross-shapedcross-section, wherein the longitudinal axis extends through a center ofthe fourth face, a top face 460 including anti-migration ridges 462, abottom face 464 including anti-migration ridges 462, and a pair of holes466 extending to and between the top face and the bottom face. The firstface, the second face and the third face form a substantially U-shapedface including a substantially U-shaped protrusion 468 extending along alength of the U-shaped face and defining a graft upper ledge 470 and agraft lower ledge 472.

In use, fourth sidewall 428 is pivoted open, and DLIF allograft bonegraft 450 is inserted into enclosure 410 through the open doorway withthe a graft upper ledge 470 engaged with the upper seat portion 440 andthe graft lower ledge 472 engaged with the lower seat portion 442.Fourth sidewall 428 is then closed and fixed shut. Once assembled, DLIFimplant 400 may be used to fuse adjacent vertebra according to themethod illustrated in FIGS. 25 through 30 and described above, with topand bottom faces 460, 464 protruding out through U-shaped slot 438 sothat anti-migration ridges 462 may directly contact adjacent thevertebrae.

What is claimed:
 1. A spinal implant comprising: a 3-D printed titaniumenclosure including, a first sidewall, a first mesh window extendingthrough the first sidewall, a second sidewall opposing the firstsidewall, a second mesh window extending through the second sidewall, asubstantially convex third sidewall extending to and between the firstsidewall and the second sidewall, the third sidewall forming a first endof the enclosure, a second end opposite the first end, a fourth sidewallopposing the third sidewall and hingedly coupled to the first sidewalland detachably coupled to the second sidewall, a longitudinal axisextending through a center of the third sidewall and a center of thefourth sidewall, a substantially U-shaped top wall with a substantiallyU-shaped top opening there through, and a substantially U-shaped bottomwall with a substantially U-shaped bottom opening there through, whereinthe first sidewall, the second sidewall and the third sidewall form asubstantially U-shaped sidewall defining a substantially U-shaped slothaving an upper seat portion and a lower seat portion, and a CNCmachined, acid treated allograft bone graft including, a first face, asecond face opposing the first face, a substantially convex third faceextending to and between the first face and the second face, wherein thelongitudinal axis extends through a center of the third face, a fourthface opposing the third face having a substantially cross-shapedcross-section, wherein the longitudinal axis extends through a center ofthe fourth face, a top face including anti-migration ridges, a bottomface including anti-migration ridges, and a hole extending to andbetween the top face and the bottom face, wherein the first face, thesecond face and the third face form a substantially U-shaped faceincluding a substantially U-shaped protrusion extending along a lengthof the U-shaped face and defining a graft upper ledge and a graft lowerledge, wherein the allograft bone graft is contained within theenclosure with the a graft upper ledge engaged with the upper seatportion and the graft lower ledge engaged with the lower seat portion.2. The implant of claim 1 wherein the top face and the bottom face taperinwardly toward the longitudinal axis at the first end of the enclosure.3. The implant of claim 1 wherein the first sidewall and the secondsidewall are parallel.
 4. The implant of claim 1 wherein the top faceand the bottom face are convex.
 5. The implant of claim 1 wherein thetop face extends out of the enclosure through the top opening and thebottom face extends out of the enclosure through the bottom opening. 6.The implant of claim 1 wherein the fourth sidewall is fabricated fromnickel titanium alloy or cobalt.
 7. The implant of claim 1 including abiomaterial contained within the hole extending to and between the topface and the bottom face.
 8. The implant of claim 1 wherein the firstsidewall is convex and the second sidewall is concave.
 9. The implant ofclaim 1 wherein the first face is convex and the second face is concave.10. The implant of claim 1 wherein the allograft bone graft ispre-hydrated.
 11. The implant of claim 1 wherein the first sidewall, thesecond sidewall, the third sidewall, the top wall and the bottom wallare porous.
 12. The implant of claim 1 wherein the first sidewall andthe second sidewall taper inwardly towards the longitudinal axis at thesecond end of the enclosure.
 13. The implant of claim 1 wherein thefirst face and the second face taper inwardly towards the longitudinalaxis at the second end of the enclosure.
 14. The implant of claim 1wherein the top face and the bottom face are parallel.
 15. The implantof claim 1 including a third mesh window extending through the firstsidewall and a fourth mesh window extending through the second sidewall.16. The implant of claim 1 including a second hole extending to andbetween the top face and the bottom face.
 17. A surgical method forvertebral interbody fusion comprising: inserting the implant of claim 1between a first vertebra and a second vertebra, wherein the surgicalmethod is a surgical procedure selected from the group consisting of aposterior lumbar interbody fusion (PLIF) procedure, an anterior lumbarinterbody fusion (ALIF) procedure, a transforaminal lumbar interbodyfusion (TLIF) procedure and a transpsoas interbody fusions (DLIF)procedure.
 18. A spinal implant comprising: an enclosure including, afirst sidewall, a first mesh window extending through the firstsidewall, a second sidewall opposing the first sidewall, a second meshwindow extending through the second sidewall, a substantially convexthird sidewall extending to and between the first sidewall and thesecond sidewall, the third sidewall forming a first end of theenclosure, a second end opposite the first end, a fourth sidewallopposing the third sidewall and hingedly coupled to the first sidewalland detachably coupled to the second sidewall, a longitudinal axisextending through a center of the third sidewall and a center of thefourth sidewall, a substantially U-shaped top wall with a substantiallyU-shaped top opening there through, and a substantially U-shaped bottomwall with a substantially U-shaped bottom opening there through, whereinthe first sidewall, the second sidewall and the third sidewall form asubstantially U-shaped sidewall defining a substantially U-shaped slothaving an upper seat portion and a lower seat portion.
 19. The implantof claim 18 including, an allograft bone graft including, a first face,a second face opposing the first face, a substantially convex third faceextending to and between the first face and the second face, wherein thelongitudinal axis extends through a center of the third face, a fourthface opposing the third face having a substantially cross-shapedcross-section, wherein the longitudinal axis extends through a center ofthe fourth face, a top face including anti-migration ridges, a bottomface including anti-migration ridges, and a hole extending to andbetween the top face and the bottom face, wherein the first face, thesecond face and the third face form a substantially U-shaped faceincluding a substantially U-shaped protrusion extending along a lengthof the U-shaped face and defining a graft upper ledge and a graft lowerledge, wherein the allograft bone graft is contained within theenclosure with the a graft upper ledge engaged with the upper seatportion and the graft lower ledge engaged with the lower seat portion.20. A spinal implant comprising: a first mesh window extending through afirst sidewall, a second mesh window extending through a secondsidewall, a substantially convex third sidewall extending to and betweenthe first sidewall and the second sidewall, the third sidewall forming afirst end of the spinal implant, a second end opposite the first end, afourth sidewall opposing the third sidewall and hingedly coupled to thefirst sidewall and detachably coupled to the second sidewall, asubstantially U-shaped top wall with a substantially U-shaped topopening there through, and a substantially U-shaped bottom wall with asubstantially U-shaped bottom opening there through, wherein the firstsidewall, the second sidewall and the third sidewall form asubstantially U-shaped sidewall defining a substantially U-shaped slot,and an allograft bone graft enclosed within the spinal implant.